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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005404
Report Date: 05/19/2022
Date Signed: 05/19/2022 10:39:07 AM

Document Has Been Signed on 05/19/2022 10:39 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:CAREASSURE RESIDENTIAL FACILITYFACILITY NUMBER:
306005404
ADMINISTRATOR:NAVAL JR, RUFINOFACILITY TYPE:
735
ADDRESS:28945 SANTIAGO PEAK LANETELEPHONE:
(949) 973-5016
CITY:TRABUCO CANYONSTATE: CAZIP CODE:
92679
CAPACITY: 4CENSUS: 4DATE:
05/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Rufino Naval, AdministratorTIME COMPLETED:
10:50 AM
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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit for the purpose of conducting a required annual inspection. LPA was greeted and granted entry into the facility by Rufino Naval, Administrator and LPA explained the nature of the visit.

LPA Martinez accompanied by Administrator began the tour of the inside and outside of the facility. Upon entry LPA observed a check in station in the main entry of the facility. There are four clients in care and there are no active covid-19 cases in the facility. LPA was informed all clients were out in the community. LPA observed required Department postings, covid-19 precautionary postings and hand washing signs throughout the facility. LPA observed the emergency disaster and evacuation plan. LPA inspected client’s bedrooms and they appeared to be clean and sanitary. All bedrooms observed to have all required components. All client bedrooms are private with one client per. All restrooms observed to have a supply of soap and appeared to be clean. Facility has a supply of emergency food, water and PPE in the attached garage. LPA toured the outside of the facility and observed a shaded seating area for client’s enjoyment. The facility has completed the LIC808 Mitigation Plan, the plan was reviewed and approved by the Department on March 12, 2021.

Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with the Administrator and a copy of this report was provided to the facility.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 05/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/19/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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